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GAVeCeLT* consensus statement on the correct use of totally implantable venous access devices for diagnostic radiology procedures.

Abstract
The use of totally implantable venous access devices in radiology may be associated with complications such as occlusion of the system (because of the high density of some contrast), infection (if the port is not handled in aseptic conditions, using proper barrier protections), and mechanical complications due to the high-pressure administration of contrast by automatic injectors (so-called power injector), including extravasation of contrast media into the soft tissues, subintimal venous or myocardial injection, or serious damage to the device itself (breakage of the external connections, dislocation of the non-coring needle, or breakage of the catheter). The last problem - i.e., the damage of the device from a power injection - is not an unjustified fear, but a reality. A warning by the US Food and Drug Administration of July 2004 reports around 250 complications of this kind, referring to both port and central venous catheters and peripherally inserted central catheter systems, which occurred over a period of several years; in all cases, the damage occurred during the injection of contrast material by means of power injectors for computed tomography or magnetic resonance imaging procedures. Though the risk associated with the use of ports in radiodiagnostics is thus clear, it has been suggested that administration of the contrast material via the port may have some advantage in terms of image quality, increased comfort for the patient, and maybe more accurate reproducibility of the patient's own follow-up exams. This contention needs to be supported by evidence. Also, since many cancer patients who need frequent computed tomography studies already have totally implantable systems, it would seem reasonable to try to define how and when such systems may safely be used. The purpose of this consensus statement is to define recommendations based on the best available evidence, for the safe use of implantable ports in radiodiagnostics.
AuthorsGiorgio Bonciarelli, Stefano Batacchi, Roberto Biffi, Massimo Buononato, Bruno Damascelli, Flavio Ghibaudo, Franco Orsi, Mauro Pittiruti, Giancarlo Scoppettuolo, Alessia Verzè, Guido Borasi, Marcello De Cicco, Roberto Dosio, Paolo Gazzo, Renzo Maso, Alessandro Roman, Vladimira Ticha, Giacomo Venier, Paul Blackburn, Godelieve A Goossens, Jamie Bowen Santolucito, Marguerite Stas, Ton Van Boxtel, Thomas M Vesely, Enrico de Lutio, Gruppo Aperto di Studio Accessi Venosi Centrali a Lungo Termine (Study Group on Long-Term Central Venous Access)
JournalThe journal of vascular access (J Vasc Access) 2011 Oct-Dec Vol. 12 Issue 4 Pg. 292-305 ISSN: 1724-6032 [Electronic] United States
PMID21534233 (Publication Type: Journal Article, Practice Guideline)
Chemical References
  • Contrast Media
Topics
  • Catheterization, Central Venous (adverse effects, instrumentation, standards)
  • Catheters, Indwelling (adverse effects, standards)
  • Contrast Media (administration & dosage)
  • Equipment Design
  • Equipment Failure
  • Humans
  • Injections
  • Magnetic Resonance Imaging, Interventional (adverse effects, instrumentation, standards)
  • Patient Safety
  • Predictive Value of Tests
  • Pressure
  • Radiography, Interventional (adverse effects, instrumentation, standards)
  • Risk Assessment
  • Risk Factors

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